Health, Hospital and Medical Care 
Needs of Virginia 
Report of the Commission 
to 
The Governor 
and 
The General Assembly 
of Virginia 
Senate Document No. 7 
Commonwealth of Virginia 
Division of Purchase and Printing 
1945 Health, Hospital and Medical Care Needs of Virginia 
MEMBERS OF THE COMMISSION 
I. C. Riggin, Chairman 
J. D. Hagood, Vice-Chairman 
H. B. Mulholland 
William B. Porter 
Jack W. Witten 
Parke P. Deans 
J. Maynard Magruder 
Joseph J. Williams, Jr. 
Ted Dalton 
Cassius M. Chichester, Secretary 
John B. Boatwright, Jr., Recording Secretary Report of Commission Appointed Under Senate Joint 
Resolution No. 2 to Study Health, Hospital 
and Medical Care Needs of Virginia 
Richmond, Virginia, November 4, 1945. 
To: 
His Excellency Governor Colgate W. Darden, Jr. 
and 
The General Assembly of Virginia 
In March, 1945, the General Assembly of Virginia adopted Senate 
Joint Resolution No. 2, creating a Commission of nine members to study 
health, hospital and medical care needs of Virginia, etc. The duties of the 
Commission as set forth in the Resolution are: 
1. The Commission shall make a thorough and complete study of 
the Department of Health of the State of Virginia, and its work 
and various activities; its needs, if any, for enlargement and expan- 
sion in order to properly meet the needs of our citizens at present and 
in the future. 
2. The Commission shall consider the question of what is the best 
manner to provide public health services, including medical and 
hospital care to those of our citizens who are financially unable to 
provide it for themselves. 
3. The Commission shall, in conjunction with the Virginia Advisory 
Legislative Council, (acting under Senate Joint Resolution Number 
Sixteen, adopted February twenty-third, nineteen hundred forty- 
four) consider the question of the medical facilities available to the 
rural population of Virginia, and what may be done to improve exist- 
ing conditions in this field, including the desirability of establishing 
“Health Centers” in various rural sections of the State. 
4. The Commission shall make a comprehensive study of the State’s 
major health problems and make its recommendations thereon. 
5. The Commission shall make a study of the advisability of a plan 
to examine and correct the physical defects of all school children, at 
private expense where possible and at public expense where necessary. 
6. The Commission shall make a study of the need of a hospital 
insurance plan for industrial workers, and other citizens. 
7. The Commission shall study the advisability of establishing a loan 
fund for those who wish to become physicians in Virginia, with extra 
inducements provided for those who will agree to practice medicine 
at least four years in rural areas. 
8. The Commission shall also study methods of enabling Negro 
youths to become physicians to serve their race, including coopera- 
tion with other nearby states in establishing a Regional Medical 
School for Negroes. 6 
Senate Document No. 7 
9. The Commission shall at least thirty days before the next regular 
session of the General Assembly make a report to the Governor of 
the result of its studies. 
The personnel of the Commission consists of: 
Dr. I. C. Riggin, State Health Commissioner, Chairman 
Dr. H. B. Mulholland, President, Medical Society of Virginia, and 
Assistant Dean, University of Virginia Medical School 
Dr. Wm. B. Porter, Medical College of Virginia 
Col, Parke P. Deans, Industrial Commission of Virginia 
Dr. J. D. Hagood, Member of State Senate 
Dr. Jack W. Witten, Member of House of Delegates 
J. Maynard Magruder, Member of House of Delegates 
Jos. J. Williams, Jr., Member of House of Delegates 
Ted Dalton, Member of State Senate 
Your Commission, in making the studies required under the Resolu- 
tion, has had several meetings, including public meetings, and has sought 
to give the problems involved careful and painstaking consideration, en- 
deavoring at all times to avoid a duplication of work being done by other 
Commissions making health studies. 
Recommendations 
The Commission recommends: 
1. (a) That adequate office and laboratory space be provided for 
the Department of Health as recommended in the report of 
the special commission appointed under Senate Joint Reso- 
lution No. 30, Regular Session, 1944. 
(b) That the local health departments in the State be increased 
from twenty-seven to fifty-one districts to provide an over-all 
health coverage for the State, and that funds be appropriated 
for this expansion. 
2. Study of the problem of indigent care having been made by a 
commission appointed under Senate Joint Resolution No. 8, Extra 
Session, 1945, no particular recommendations are given on this sub- 
ject herein. 
3. The topic of rural health having been more fully considered by a 
committee of the Virginia Advisory Legislative Council, your Com- 
mission urges the adoption of those measures which will provide 
better medical care for the rural areas. 
4. That the necessary facilities and personnel be provided for the 
State Department of Health to carry out its many and increasingly 
important functions and for the expansion of its work as recom- 
mended in this report. 
5. That a compulsory periodic medical examination be required of 
all school children in Virginia, and that the defects discovered be 
corrected on a voluntary basis in the best practicable manner; and 
that an appropriation of $500,000 be made available for this pro- 
gram. Health, Hospital and Medical Care Needs of Virginia 
7 
6. That the sum of $10,000 annually for the next biennium be ap- 
propriated to the Department of Health for the purpose of institut- 
ing an educational program for the extension of pre-payment hospi- 
tal and medical care to cover industrial and agricultural workers and 
their families. 
7. That the sum of $25,000 each be made available annually to 
the two medical schools as a loan fund to help supply doctors to 
rural areas. 
8. That increased allowances for Negro medical and dental students 
be supplied in the discretion of the Governor. 
9. That a single continuing commission be created for the study 
and coordination of all health subjects. 
The Department of Health—its History, 
Organization and Functions 
From a modest beginning under an act of the General Assembly- 
passed in 1872, creating a State Board of Health, Virginia has made a 
great deal of progress in caring for the health of her people. The first 
work consisted of effort directed toward the control of epidemics, prin- 
cipally smallpox, and the distribution of a limited amount of health 
literature. The effectiveness of even this slight work was recognized, and 
in 1908 the Department of Health was established. From the start the 
growth of the State Department of Health has been gradual, but con- 
tinuous, and the State Department of Health, as it now exists as an offi- 
cial department of State government, was created in 1927 under the Byrd 
reorganization act. With the assistance of the Department of Health, in 
1916 the first county health department was organized and began its 
service in Norfolk County, and by 1933 sixteen counties had public health 
service. In 1935 Federal funds were made available through the State 
Health Department to subsidize counties that desired a health service, 
and with these funds available there has been a further expansion of health 
services until at the present time there are fifty-one counties compris- 
ing twenty-six districts that have a health service. Approximately 68 per 
cent of the rural and 7 per cent of the city population are served by these 
health districts. 
From three offices and a laboratory in 1908, with expenditures of 
$10,000, the Department of Health now has expenditures of approxi- 
mately $1,000,000 annually, and it has necessarily expanded to the point 
of needing much additional office space and better laboratory facilities. 
The State Department of Health with other agencies of the State 
government is attempting to achieve certain objectives. The over-all ob- 
jective of the Department is to protect, promote, and prolong the good 
health of the general public. Progress in the achievement of this objective 
has already been made. Organization is of utmost importance in the oper- 
ation of an agency, and with changing conditions in public health, organ- 
ization must be dynamic and not static in nature. The Health Department 
has endeavored to have the most effective organization possible under the 
circumstances in its efforts to promote, protect, and prolong the health 
of the people. It seems evident, however, that with the increased demands 8 
Senate Document No. 7 
RURAL 
HEALTH 
TUBERCULOSIS 
OUT-PATIENT 
SERVICE 
COMMUNICABLE 
DISEASES 
VENEREAL 
DISEASE 
CONTROL 
CRIPPLED 
CHILDREN 
ORGANIZATION CHART 
of 
THE STATE DEPARTMENT OF HEALTH 
HEALTH EDUCATION 
PUBLIC 
HEALTH 
NURSING 
Virginia Department of Health 
State Health Commissioner 
Administration 
VITAL 
STATISTICS 
Governor 
LABORATORIES 
TUBERCULOSIS SANATORIA 
State Board of Health 
INDUSTRIAL 
HYGIENE 
MATERNAL AND 
CHILD HEALTH 
MOUTH 
HYGIENE 
SANITARY 
ENGINEERING 
SHELLFISH 
SANITATION Health, Hospital and Medical Care Needs of Virginia 
9 
of the public for health services with the present organizational setup 
and the limited number of personnel, it is unable to provide adequately 
the services demanded and needed by the citizens. 
The major activities* of the State Department of Health are; 
Rural Health 
Communicable Diseases 
Pneumonia Control 
Venereal Disease Control 
Laboratories 
Sanitary Engineering 
Water Supplies 
Sewerage and Sewage Disposal 
Stream Pollution 
Shellfish Inspection and Sanitation 
Malaria Control 
Swimming Pools and Bathing Beaches 
Maternal and Child Health 
Mouth Hygiene 
Public Health Nursing 
Crippled Children’s Bureau 
Industrial Hygiene 
Tuberculosis Out-Patient Service 
State Tuberculosis Sanatoria 
State Subsidy to Local Tuberculosis Sanatoria 
Public Health Education 
Vital Statistics 
Administration and operation of the personnel system and related 
activities 
Administers in-service training 
Cooperates with the U. S. Public Health Service in operation of the 
two rapid treatment centers for venereal diseases 
Administers the Emergency Maternal and Infant Care program 
Conducts orientation periods for student nurses in public health 
from the Medical College of Virginia and supervises their rural 
experience 
Maintains and operates diagnostic clinics, supervises hospital and 
convalescent care, provides follow-up care and supervision by 
nurses and medical social workers in the home, conducts surveys 
and sampling to determine incidence of rheumatic fever in va- 
rious population groups, and carries on epidemiological investi- 
gations to determine the channels of spread in the rheumatic 
fever control program. 
*Note; See Bulletin State Department of Health 1942. 
MAJOR HEALTH PROBLEMS 
The Commission in undertaking the study of the State’s major 
health problems finds many interesting facts which indicate that many 
of them still remain unsolved. Measures to alleviate, correct, and abate 10 
Senate Document No. 7 
some of these problems are already underway. In some instances even 
though the problems were known, no measures have been undertaken 
because of the lack of funds and personnel. The Commission has deemed 
it neither advisable nor possible to study and report on every health 
matter in Virginia, but submits the following as its findings on some of 
the outstanding health problems. 
Tuberculosis 
Virginia has a consistently higher death rate from tuberculosis for 
a nine-year period than that of the United States as a whole. The 
fact that the rate in Virginia shows a steady decline over this period 
is evidence that the program of tuberculosis control in Virginia is effec- 
tive, yet by all standards the mortality and morbidity rates are yet en- 
tirely too high. With a more intensive tuberculosis control program, it 
may fairly be expected that the death rate from this disease will continue 
to show a decrease. 
There is in all probability a total of 20,000 cases of clinical tubercu- 
losis in the State, and it has been impossible in the past to adequately care 
for this number with the available facilities and personnel. This disease, 
which is recognized as being curable in its early stages, was responsible 
for 1,287 deaths in the State during 1944. Many, perhaps most of these 
lives, could have been saved by adequate provisions for necessary clinical 
and hospital services. In addition to these deaths, hundreds of others have 
been incapacitated by this disease and are a burden and a hazard to their 
families and communities. 
To accomplish a reduction in the tuberculosis death rate involves: 
(1) The maintenance of an active registry of deaths, active cases, 
suspected cases, contacts, and suspected contacts. 
(2) The location of cases, suspects, and contacts. 
(3) Provision for diagnostic service which includes physical exam- 
inations, X-ray examinations, tuberculin testing, and consulta- 
tion service for patients referred by physicians to clinics oper- 
ating on a regular schedule. 
(4) Operation of a state-wide collapse therapy program for indigent 
pneumothorax patients, 
(5) The furnishing of hospitalization for patients requiring major 
surgical operations. 
(6) Provision of a follow-up nursing service for assistance to physi- 
cians in the supervision of open cases, for instruction of patients 
as to care and precautions to be instituted for the protection 
of contacts; the selection of cases for institutional care. 
(7) An increase of field pneumothorax stations should be made 
from the existing 54 to 75, so that no patient will have to travel 
a greater distance than 20 miles for refills. 
(8) There should be an increase in the number of beds at the State 
Sanatoria so that infirmary as well as ambulatory patients will 
be able to receive sanatorium care and treatment. Health, Hospital and Medical Care Needs of Virginia 
11 
In this connection your Commission calls the attention of the Gov- 
ernor and the General Assembly to the fact that there is no place in 
Virginia to which diabetics afflicted with tuberculosis may go. Something 
should be done about this. 
As a special commission was created by the General Assembly to 
study the tuberculosis problem, this Commission is not including in its 
report a more detailed statement. 
Crippled Children 
Crippled children have been and always will be of great concern 
to the citizenry in general, and are of more concern to the parent. The 
cost involved in the prolonged treatment of some of these conditions 
makes it almost prohibitive to the individuals in a large percentage of 
these cases. 
With this knowledge the State has deemed it necessary and wise 
to make funds available, approximately $38,000, to assist this group in 
correcting these defects where possible. In the past only those children 
under 16 years of age have been participants in this program. The age 
limit has recently been raised to 21 years; and with accidents listed in 
fifth place in the ten leading causes of death in Virginia, we may well 
expect the active case load of 10,000 to show a marked increase. In the 
past no accident prevention and safety program has been undertaken as 
a function of the Health Department. More stress should be laid upon 
this important activity of caring for crippled children. 
Orthopedic clinics were formerly scheduled in forty-one counties 
in the State, but due to so many orthopedists being in the armed forces 
some of them have had to be discontinued. These clinics should be re- 
sumed and additional clinics established, and so located that they will 
be available for patients in each county. 
Hospitalization and convalescent care is a requirement in the treat- 
ment of crippled children if effective results are to be obtained. An ex- 
pansion of the Rucker Convalescent Home at Charlottesville, with the 
establishment of a convalescent home in connection with the Crippled 
Children’s Hospital at Richmond and also one in connection with the 
Medical College of Virginia should be made available at once. The latter 
should be for convalescent Negro children with orthopedic conditions. No 
program of treatment is available for cerebral and spastic paralysis cases 
in Virginia, and there should be established a special clinic with a ward 
to provide for this type of case. Personnel consisting of additional orth- 
opedic nurses, physical therapists, and plastic surgeons must be provided 
to adequately meet this health problem. 
There has been ample demonstration to show that with proper treat- 
ment and care many of those with crippling conditions can be so im- 
proved that they will be able to lead a normal and productive life. 
Rheumatic Fever 
Only within recent years has rheumatic fever been given serious 
consideration as a health problem, and only quite recently has it been 12 
Senate Document No. 7 
realized that rheumatic fever was a problem in the Southern states as 
well as those states with a uniformly colder climate. In 1940 the Virginia 
State Department of Health undertook a study to ascertain information 
as to the incidence of rheumatic fever in Virginia. This study was begun 
in Henrico County and has been extended to include several other coun- 
ties. This study has shown definitely that rheumatic fever and chronic 
rheumatic heart disease is a major health problem. The importance of 
this disease in Virginia is indicated in Table No. I filed herewith, which 
shows that the death rate in Virginia is approximately the same as that 
for the United States as a whole and stands among the first eight as to 
causes of death. 
In a special Report of Mortality Summary, U. S. Bureau of Census, 
it is estimated that the incidence of rheumatic fever is 1 per cent of the 
school population. This report also states that “nearly all heart diseases 
among persons 5 to 24 years of age are of rheumatic origin.” The report 
further states that only 5 per cent of those having a rheumatic infection 
beginning in childhood reach an age beyond 45. With the death rate of 
Virgina paralleling that of the nation as a whole the incidence of the 
disease should also be comparable to that of the nation. 
From studies made by other states in rheumatic fever control, it has 
been definitely shown that individuals suffering from this disease require 
hospitalization and convalescent care if the number of permanently 
crippled is to be decreased and the mortality rate lowered. 
The establishment of rheumatic fever clinics located throughout 
the State so that service of these clinics will be available to all the people, 
arrangements for the hospitalization of all cases needing such care, and 
the development of a state-wide program by the State Department of 
Health along the lines established elsewhere which have proven effective, 
are recommendations for more effective control measures. 
Maternal and Child Health 
Maternal and infant mortality, plus premature births, as shown by 
Table No. I, is another major health problem in Virginia. Thirty-nine 
states have a lower maternal death rate than Virginia, and thirty-seven 
states have a lower infant mortality rate. The solution to this problem 
is one of practical demonstration and education. Proper education of 
the general population as to the need of prenatal and postnatal care as 
well as educating those administering such care would definitely reduce 
these extremely high death rates. A widespread use of midwives (Virginia 
stands 39th in live births not attended by physicians) no doubt contrib- 
uted to these causes of deaths in Virginia; therefore a recognized pro- 
gram of control over midwives is advisable. 
The program should be one of educating the general population and 
professional personnel, and not necessarily one of medical care per se. 
The establishment of clinics is purely a means of teaching the people the 
value of certain procedures and practices. Health supervision of preschool 
children should be more detailed. Routine physical examinations, inspec- 
tions, and immunizations should be procedures covering all children up 
to school age. Pediatric medical care will require that clinics be established Health, Hospital and Medical Care Needs of Virginia 
throughout the State in addition to the well-baby clinics that are now 
being conducted. A follow-up of neonatal and infant deaths should be 
instituted in an effort to lower the infant morbidity and mortality rates. 
The survey of maternal deaths should be continued as it was before the 
war. Previously there were 170 M. C. H. clinics being conducted in the 
State; this number should be approximately doubled. 
The Training Center for the care of premature infants established 
previous to the war, but discontinued, should be re-established and other 
centers opened. Maternity hospitals licensed under the Maternity Hospi- 
tal Law should be followed more closely by an advisory service of ob- 
stetricians and pediatricians. More intensive follow-up of prenatal pa- 
tients suffering with tuberculosis should be carried on and hospital facili- 
ties for delivery of such patients made available. 
The nutrition program has proven to be of value and will be more 
in demand in the future. Specialized services in nutrition should be ex- 
panded to all local health districts and to interested organizations and 
individuals. Nutritional advisory service should be given to schools, clin- 
ics, dietary departments of small hospitals, and to industries. 
The suffering of those with cancer as well as the number of deaths 
due to this disease is a problem that is of grave concern. Cancer as the 
cause of death climbed from sixth place in 1940 to third in 1944 in the 
ten leading causes of death in Virginia. Table No. I shows Virginia as 
having a lower death rate from cancer than the United States as a whole. 
The probable reason for this is that in Virginia the population consists 
of a large percentage of colored people, and this group does not suffer 
from cancer of certain types as the white population does, and, too, 
diagnostic facilities are not as available to the colored as they are to the 
white. The fact that cancer as a cause of death has shown a steady in- 
crease over the years is indicative of the fact that intensive efforts must 
be undertaken to alleviate the suffering and reduce the deaths from this 
disease. 
Recognizing the established fact that early diagnosis and proper treat- 
ment of cancer cases is the only method of reducing the cancer death 
rate, it is recommended that a program be organized to make available 
effective services not only to the urban people, but to the rural as well. 
To make effective such services will necessitate the establishment of 
a Division of Cancer Control, the program to include the operation of a 
mobile clinic for the early diagnosis of malignancies and the performance 
of specialized diagnostic laboratory procedures necessary in the recogni- 
tion of malignancies and study of pathological tissues. A mobile unit 
properly staffed could visit any section of Virginia for diagnostic, consulta- 
tive, and instructive purposes. Private patients of physicians, and indigent 
suspects in this way would be reached without delay, fulfilling the need 
for early diagnosis. 
The follow-up by nurses of the respective local health departments 
on suspected cases and on patients having a diagnosis of a malignancy 
Cancer 14 
Senate Document No. 7 
is necessary if effective results are to be obtained in a cancer control 
program. 
Trachoma and Goiter 
In certain sections of the State there is a marked prevalence of two 
diseases, trachoma and goiter. No organized program for the prevention, 
control, or eradication of these afflictions has been undertaken. A special 
program should be inaugurated to study and institute measures to prevent 
the further spread of these ailments, to alleviate the suffering caused by 
them, and to prevent the development of blindness from those suffering 
from trachoma. 
Venereal Disease 
Syphilis presents a major problem. This disease is listed as one of the 
ten leading causes of death in Virginia. Not only does the disease cause 
many deaths, but a large percentage of the patients at the State mental 
institutions are there because of conditions brought on by syphilis. The 
Selective Service Act and Virginia Premarital Law have uncovered many 
cases of this disease which would never have been known to exist had not 
these groups of people been examined. Means should be devised to treat 
early syphilis so that the number of mental cases would be reduced and 
the death rate lowered to the very minimum. The incidence of gonorrhea 
in Virginia is seven times that of syphilis from the standpoint of numbers. 
Many individuals, male and female, are crippled by conditions resulting 
from this infection, and a number of deaths are caused by involvement 
of the heart by this organism. 
The program of Venereal Disease Control has only partially met 
the need of the State because of many factors, and is inadequate in locat- 
ing contacts and in the following-up of known patients with the disease 
under treatment at the clinics and by the private physicians. This can be 
remedied only by having sufficiently trained investigators and nurses 
located throughout the State. The continuation and maintenance of the 
present clinics and the establishment of additional clinics and treatment 
centers which will be available to those needing treatment in all sections 
of the State, is essential. 
NEEDS OF HEALTH DEPARTMENT FOR ENLARGEMENT 
AND EXPANSION 
Office and Laboratory Space 
A primary need of the State Department of Health is an adequate 
and suitable building at Richmond for the housing of this increasingly 
important department of the State government. The commission appoint- 
ed to make a special study of the need for office and laboratory space for 
the department has already so reported, and we concur in the findings 
of said commission. Health, Hospital and Medical Care Needs of Virginia 
15 
Control over communicable diseases was the basis for the founding 
of public health services. Today the people are confronted with practi- 
cally all of the old communicable diseases and many new ones. With 
some of the new diseases, means of control have been devised, but approx- 
imately 50 per cent of all clinical epidemiological problems are due to 
unknown entities and remain unsolved. With returning personnel of the 
armed forces and an increase generally in international traffic, we may 
expect an experience with diseases not encountered in this country before. 
These facts alone point to the need of clinical and laboratory research 
in an effort to further control communicable diseases. 
At the present there is only one hospital in Virginia (Norfolk) that 
has proper facilities for the treatment of acute communicable diseases. 
Hospital facilities for this purpose should be established in at least four 
sections of the State. A problem encountered in the study of an outbreak 
of a communicable disease is the lack of adequate laboratory facilities at 
the site of the outbreak; these facilities are necessary in the proper con- 
duct of an epidemiological investigation. 
There is need for the establishment of facilities in areas of the State 
for the treatment of acute communicable diseases. One of these centers 
comprising a unit each should be located at the University Hospital and 
another at the Medical College of Virginia; the remaining two units to 
be located near or in Roanoke and Norfolk. 
Table No. II giving the median figure of the occurrence of the usual 
communicable disease shows in the total by months the need for hospital 
beds. It will be seen that the least number of cases for the diseases listed 
occur during the months of June and July, and that at this time 120 
potential patients for hospitalization exist. 
Prior to the period of war emergency a mobile unit, trailer in 
nature, was planned for the investigation, on location, of sanitary and 
communicable disease problems. The development of this plan was 
prevented, because of the war and the acquisition of the then State-em- 
ployed personnel by the armed services. This plan for such a mobile unit 
should now be carried out. 
Communicable Diseases 
Sanitary Engineering 
Within the next few years it may be expected that a considerable 
number of towns and cities will extend existing sewage disposal systems 
and water works, construct new sewage treatment plants, garbage and 
rubbish disposal plants, provide drainage, and take other sanitary meas- 
ures. Also stream pollution, and other industrial wastes will require at- 
tention. Too, under this heading, the supervision of the shellfish industry 
and the protection of our population from contaminated sea food will 
require considerable thought. Provisions for service in these fields must 
be met. 16 
Senate Document No. 7 
The State Health laboratories in Virginia are not in a position to 
carry on research that is necessary to keep in step with modern public 
health practices, nor are they in a position to meet the demands made 
by physicians and others in the State for certain types of examinations 
that must be made routinely. A laboratory operated by a State depart- 
ment, for all practical purposes, should have no limit placed on the 
amount and type of service it can render the citizenry. 
The laboratory of the State Health Department has not undertaken 
a number of services demanded because of lack of space and shortage 
of personnel. There is no remedy for this situation until facilities and 
space are made available, which we hope will be made one of the first 
of Virginia’s postwar projects. 
A suitable animal house should be constructed and maintained at 
the Virginia State Prison for Men in Goochland County. The building 
should be so constructed that animals could be properly housed and 
bred. The animals produced such as white mice, rats, guinea pigs, and 
rabbits could be furnished to all State Laboratories at cost and could act 
as a reservoir for experimental purposes for the State Health Depart- 
ment. It is believed that there would be little expense above the primary 
outlay of funds, and that the animal house eventually would pay for 
itself. 
Laboratories 
Industrial Hygiene 
Industry in Virginia is constantly increasing, both large and small. 
The State Health Department will not be able to meet the demands made 
upon it for service unless this bureau is enlarged. While serving industry 
and protecting the health of the employees this bureau should at all times 
have personnel and facilities for a certain amount of research. We must 
recognize that Virginia is fast becoming an industrial state. 
Mouth Hygiene 
The future life of a child may be jeopardized bv the faulty mouth 
hygiene of its youth. A program of mouth hygiene should be made avail- 
able to every child in Virginia if for no other reason that that of education. 
Virginia has never offered this service on a large enough scale. The max- 
imum number of dentists at any one time being employed in the dental 
hygiene program has been twenty-one. At present only seven are em- 
ployed. Almost two-thirds of our young adults have dental defects which 
can and should be corrected. 
Health Education 
Education is just as important in public health as in other fields. 
The State Department of Health established a Division of Health Educa- 
tion in 1936. However, the program of health education is neither spe- 
cific enough, nor broad enough in its coverage to meet the requirements 
in this field, and Virginia is lagging behind in its educational services as Health, Hospital and Medical Care Needs of Virginia 
17 
applied to public health. The program of education in public health must 
be broadened and this department sufficiently staffed with qualified per- 
sonnel, which will cost an additional sum of approximately $18,000 per 
year. 
Health Statistical Data 
At present either by law or by direction or by demands of operation, 
practically every subdivision of the Health Department is involved in a 
system of reports and statistics. Some 260 reports, forms, and records, 
exclusive of fiscal purchasing, personnel, and property forms, are in use. 
Some 90 employees are engaged in processing and filling out records of 
various kinds. Under the system of manual recording, it is impossible to 
have the thousands of items of basic data of the department fully ana- 
lyzed for useful activity and program planning. The installation of a 
single integrated mechanical system, with the improvement of the neces- 
sary manual features will go far toward making available the factual 
data required by the Health Department to properly coordinate its func- 
tions. Not only can proper statistics and records be obtained through the 
installation of such a recording and tabulating unit, but such data can 
be advantageously used for health research. 
Local Health Departments 
The Commission is definitely cognizant of the fact that even with 
the expansion of the fuctions and activities of the central office of the 
State Department of Health, adequate public health protection can only 
be provided to the citizens if these services are made available to the 
local areas in the form of county or city health departments. The most 
satisfactory and effective unit of organization to perform a state-wide 
service is the county or city health department which of necessity must 
utilize its influence and perform its functions as an essential subdivision 
of local government. Furthermore, to make effective programs of service 
such as the control of Tuberculosis, Venereal Disease, Communicable 
Diseases, Cancer, and render Maternity and Child Health and Crippled 
Children’s services, it is fundamental that the basis of any such service is 
the local health department. 
As previously noted the first full-time county health department 
was organized in Norfolk County in 1916. Between that time and 1934 
fifteen additional counties in Virginia authorized and conducted county 
health departments. During 1935 as a result of the passage by Congress 
of the Social Security Act there became available to the several states 
funds for distribution through the State Health Department to localities 
for the purpose of aiding in financing local health departments. As a re- 
sult of the availability of these funds the number of counties establishing 
health departments has steadily increased until at present there are fifty- 
one counties having full-time health service. Although local health serv- 
ices have not been organized on a. state-wide basis to date, the effective- 
ness of the programs conducted by existing local health departments and 
the State Department of Health is indicated by Table III. 18 
Senate Document No. 7 
It is believed by the Commission that if during the period shown 
in Table III organized health work on a local basis had been available 
to all areas and the citizens of the State, greater reduction in the number 
of cases of these diseases would have taken place. The county health 
departments now in existence are serving a population of 1,284,767, Or- 
ganized services should be made available to the remaining rural popula- 
tion totaling an additional 757,000. Thus the primary need is to establish 
organized health departments to serve every county in the State and to 
expand those local health departments already in existence sufficiently to 
furnish a reasonably adequate health service to their respective communi- 
ties; this service to include not only the services being now rendered, such 
as immunization clinics, venereal disease clinics, tuberculosis clinics, mater- 
nal and child health clinics, preschool clinics, and home nursing and 
sanitation visits, but the service should also include a broad educational 
program covering both adult and school groups, guidance and correlation 
of all health activity in the locality, and the planning and execution of ad- 
ditional progressive programs consistent with good public health practices. 
These are now available only in part because of lack of funds to provide 
adequate facilities and personnel. 
The present health services being conducted in the fifty-one coun- 
ties follow a prescribed pattern. While such a program heretofore has 
been considered adequate, advances in public health knowledge warrant 
the addition of such services as those in the field of nutrition, rheumatic 
fever, cancer control, et cetera, as well as further expansion of the exist- 
ing programs. The limitation of services rendered a community is in 
direct ratio to the number of qualified personnel available. Prior to the 
outbreak of the war in those sections of the State with organized health 
departments, efforts were made to plan for these departments a well- 
rounded and balanced program. The drain from these services of profes- 
sional and technical personnel has resulted in the reduction of the 
number of qualified individuals serving with these local departments, 
which has reflected unfavorably on the sum total of accomplishments. 
For example, many local health departments which formerly had two or 
more public health nurses now only have one, and some are without 
any medical personnel. Sanitary engineers too were lost in large numbers. 
In addition, the public is demanding increased services. The national 
standard for public health personnel is one medical officer for approxi- 
mately each 50,000 population in rural areas, one nurse for each 5,000 
population, and one sanitation officer for each 10,000 population. In 
Virginia many of the departments with large areas have had only one 
nurse for 25,000 population, one health officer for 100,000 or more, and 
one sanitation officer for 60,000. It is obvious that adequate services can- 
not be rendered with this small number of personnel per unit population. 
To provide a state-wide coverage with local health service, twenty- 
four additional local health districts must be established making a total 
of fifty-one health districts for the State; these districts including from one 
to four counties, with an average population of 50,000 per district. The 
proposed geographical location of such districts is illustrated on Map Health, Hospital and Medical Care Needs of Virginia 
19 
No. 1. It is contemplated that these arrangements for health districts 
be very flexible in order that final geographic adjustments could be made 
so as to meet the needs and desires of the governing bodies of the locali- 
ties. Any such readjustment of the geographical locations recommended 
would not seriously alter the plan for state-wide coverage or the necessary 
financial outlay. The professional personnel required for the operation 
of such coverage would be fifty-one health officers, one public health 
nurse for each 7,500 population, one sanitation officer for each 20,000 
population, and one dentist for each 50,000 population. For effective 
administration of this over-all plan consideration must be given to the 
establishment of four administrative districts, each district consisting 
of component health districts or county health departments, as illustrated 
in Table IV. 
The budget for the year 1944-45 for the operation and supervision 
of the existing twenty-seven health departments totals approximately 
$970,245. The estimate of the cost for the extension of health services 
to include fifty-one health departments with adequately trained person- 
nel is approximately $2,261,000. The kind and number of personnel now 
employed in the existing twenty-seven districts and the number of per- 
sonnel required for the proposed fifty-one districts is as follows: 
Present 
Proposed 
Personnel 
Personnel 
Increase 
Health Officers 
27 
52* 
25 
Public Health Nurses 
Ill 
259 
148 
Sanitation Officers 
62 
100 
38 
Clerks 
66 
105 
39 
Dentists 
0 
51 
51 
Advisory Personnel and Clerks .... 
21 
56** 
35 
287 
623 
336 
*Includes one assistant 
**Includes the additional physicians for school health program. 
Through the establishment of the fifty-one districts, an adequate 
health service could and would be created in each of the one hundred 
counties of the State. Only when a coverage includes the entire popula- 
tion of the State will all the people have the advantages of the known 
benefits for health protection. As it now exists forty-nine counties are 
paying taxes for the purpose, but are deriving little benefit from local 
public health services. 
The Commission is of the opinion that the funds necessary to carry 
out the above expansion should be forthwith provided. It will be one 
of the best investments that Virginia can make for the health, happiness 
and well-being of its citizens. 20 
Senate Document No. 7 
Hospital Insurance 
for Industrial Workers and Others 
The Commission is firmly of the opinion that the citizens of Virginia 
should have the widest possible hospital insurance coverage. Workmen’s 
Compensation insurance has been helpful to the worker, and it has been 
suggested that its coverage should be broadened io include all agricul- 
tural workers and all industrial employers employing three or more per- 
sons. And, many think that a comprehensive system of health insurance, 
offering both medical and hospital care as well as cash benefits for loss 
of time, is on its way. But for the time being the thought of the Commis- 
sion is to make hospital care insurance as universal in Virginia as may 
be done without compulsion. Hospital care insurance fills the large gap 
not taken care of by Workmen’s Compensation in providing hospital care 
for sickness befalling the employee, and further by providing hospital 
care for the family of the employee. To provide for hospital costs by a 
pre-payment plan is of real importance. The theory upon which hospital 
insurance is based is just as sound and prudent as the carrying of fire and 
life insurance. A general recognition of the value of hospital insurance is 
shown by the fact that already approximately one out of every six Amer- 
icans are now paying hospital bills in advance through some form of 
hospital insurance. 
Virginia is below the national average in hospital care coverage. A 
representative of a non-profit pre-payment plan has given us an estimate 
that only approximately 250,000 people in Virginia have hospital insur- 
ance. To increase the amount of hospital coverage for the citizens of 
Virginia is an aim to which our attention should be directed. It is cer- 
tainly a fertile field for work; it is a field in which the industrial workers 
should all be enlisted. Statistics generally show that those least able to 
pay for hospitalization usually need it most. High cost medical care goes 
hand in hand with low income. About one person in ten needs hospitaliza- 
tion each year, and the financial burden of such care is too great for 
many industrial and agricultural workers to bear. 
There are 14,000 employers in Virginia carrying Workmen’s Com- 
sation insurance. Questionnaires were sent 1,807 of these firms inquir- 
ing about the insurance provided for theii employees, and 760 answers 
were returned. From this survey we found that about one-half of the 
employers provide some type of group insurance, such as life, accident and 
health, a retirement plan, and quite a number have hospitalization and 
medical care insurance. Such insurance has increased in each ten-year 
period since 1910, and since 1920 hospitalization and medical care pro- 
grams have had a steady and a healthy growth. Moreover, it is noted 
that the group insurance coverage increases in proportion to the number 
of employees per firm. A further observation from the survey is that the 
majority of employees who were participants in group insurance plans 
felt that they were better off than the employees who belonged to no 
such plan, and approximately 93 per cent of the firms expressing views 
on the subject stated that employee morale was definitely improved 
through the operation of their group insurance program. A chief weak- Health, Hospital and Medical Care Needs of Virginia 
21 
ness indicated in the group policies is that the insurance protection in 
many instances ceases when employment ends. However, the survey defi- 
nitely convinces us that both the employei and the employee are favor- 
able to hospital insurance coverage. It being a voluntary proposition, 
necessarily, it is slow to obtain anything near adequate coverage. 
It is more difficult to enroll the farmer than the industrial worker. 
Only a negligible percentage of the farm families of Virginia carry hospi- 
tal insurance. It is an industry little organized and widely scattered with 
probably 200,000 farms involved. In a couple of Virginia counties where 
the Blue Cross made some considerable effort less than 10 per cent of 
the farmers enrolled. Obviously, it is going to require an intensive educa- 
tional program to enroll the farmer. Once they are enrolled, and fully 
understand the value of hospital insurance, they are its most ardent ad- 
vocates. The pre-payment of hospital care is a great need for those of 
modest incomes. 
A general program can and should be worked out whereby all the 
families of this Commonwealth may be informed of the value and bene- 
fits of prepaid hospital care. 
Such a program must have an educational basis. The furtherance of 
the work will, more or less, involve a selling of the idea to the people, 
but reduced to its last analysis, it is the salesmanship of a social program 
that will provide for hospital care without the cost being a burden or 
hardship. 
Experience indicates that non-profit hospital care plans are offered 
at a relatively low cost which is adequate to meet the needs of the average 
citizen of Virginia. 
Thousands of farmers and industrial workers are yet unfamiliar with 
these plans, and they would find comfort and economy under their pro- 
tection. Such non-profit plans have the approval of National and State 
Hospital and Medical Associations, including the approval of the Medical 
Society of Virginia, and one such plan, namely the Blue Cross now has 
17,500,000 members enrolled in the United States. Other contracts for 
prepaid medical care cover between 4,000,000 and 5,000,000 people in 
our nation. The Virginia percentage of population covered in all of these 
plans averages much below the national average. 
In 1945 the North Carolina Health and Medical Care Commission 
of fifty outstanding physicians and citizens, headed by Dr. Clarence Poe, 
reported: 
“IN ORDER both to remedy the most urgent needs of today 
and work toward the larger program of tomorrow, three things are 
supremely needed—MORE DOCTORS, MORE HOSPITALS, 
MORE INSURANCE. These are the three mutually indispensable 
legs of our three-legged stool. 
“We cannot have enough doctors without more hospitals . . . nor 
enough hospitals without greater popular ability to pay for hospital 
service . . . and such ability to pay on the part of the poorer half 
of our population is impossible without insurance.” 22 
Senate Document No. 7 
Your Commission sincerely feels and so reports that the State 
of Virginia should encourage hospital care insurance for farm and indus- 
trial workers. The public is entitled to our assistance in this phase of the 
fight against the costs of disease and illness. The trend of the people is 
toward better health and hospital care, and the practice of installment 
payments is already well established. 
Recognizing the need in Virginia for the extension of hospital care 
coverage, the real question is the method by which this may be achieved. 
Suggestions vary almost with the individual or group interviewed, but 
your Commission feels that a cross-section of the best opinion available 
on the subject is that the correct approach to the problem is an educa- 
tional one. This will require much detailed effort, for example, a broad 
publicity program, and considerable time and expense to carry the in- 
formation to every corner of the State. Your Commission feels that the 
work required can best be done by the State Department of Health, and 
it will require a full-time person to supervise, coordinate and direct the 
activities incident to this work. And this program should be so organized 
in the Department of Health that knowledge of the subject will be brought 
in so far as practicable to every family in Virginia that might possibly be 
enrolled. The cost of such a program, while substantial, will not be un- 
reasonable in view of the good to be accomplished. Probably $10,000 an- 
nually for the next couple of years would be sufficient for the purpose. 
Incidentally, your Commission is of the opinion that this would not be a 
recurring expense, for once it is thoroughly established among the people, 
the enrollees will be its best advertisers. 
Admittedly, the extension of hospital care coverage by an educa- 
tional process is far short of the need, but it is a step in the right direction. 
And it is our duty to make every reasonable move that leads toward 
solving our State health problems. 
Rural Health 
Two members of this Commission are members of the committee 
acting under S. J. R. No. 16, of the Virginia Advisory Legislative Coun- 
cil to study rural health and medical care. The report submitted to the 
Council by the committee has shown an appalling lack of medical care 
in rural Virginia, and reference is here made to the findings of that 
committee giving the picture of the situation that exists in this field. 
The Commission substantially agrees with the recommendations con- 
tained in said report, and urges the adoption of measures which will pro- 
vide for adequate medical care throughout the rural areas of the State. 
Unquestionably, there exists in Virginia a lack of physicians in many 
rural areas. One of the steps considered by the committee of V. A. L. C. 
in order to supply doctors to the rural areas, is to supplement the loan 
funds to medical students studying in the two State medical schools, pro- 
Loan Funds for Medical Students to Practice in Rural Areas Health, Hospital and Medical Care Needs of Virginia 
23 
vided such students will agree to practice at least four years after gradua- 
tion in rural areas. This Commission believes that the amount suggested, 
namely $25,000 annually to each medical school to be used as such a loan 
fund would materially help to supply doctors to the rural areas of the 
State, and, therefore, we strongly recommend that the above fund be 
made available for this purpose. 
Virginia is operating under an arrangement with Meharry Medical 
College, at Memphis, Tennessee, whereby allowance is made by the State 
of Virginia for scholarships for the training of the Negro medical students 
from Virginia in an accredited medical school. The release of many pros- 
pective Negro medical students from the armed services will likely soon 
call for increased allowances from the State for this purpose, and also 
a number of Negro youths will probably desire to enroll as dental students 
elsewhere. Your Commission has not been able to determine the approxi- 
mate sum needed for this scholarship assistance, but they feel that whatever 
may be needed for the purpose should be cheerfully supplied. The Negro 
death rate in Virginia is much higher than the white death rate. We 
should do anything that we can to enable capable Negro youths to become 
physicians and dentists to serve their race, and a continuation of this study 
should be made by the Department of Health, and any needed amounts 
for aiding the Negroes in medical and dental education should be left to 
the discretion of the Governor of Virginia. 
Facilities for Negro Medical Students 
Medical Aid for Indigents 
Since the problem of what is the best manner to provide health serv- 
ices for the indigent has been considered by a commission appointed 
under Senate Joint Resolution No. 8, and a detailed report filed, your 
Commission has not duplicated this work. 
Medical Examination of School Children and Correction of Defects 
Reference to this subject was made in the report of the Virginia 
Education Commission in 1944 as follows: 
“It is strongly recommended by the Commission that provision 
be made for each school child in the State to have periodically a 
complete physical examination with an efficient follow-up system to 
assure the correction of the health and physical defects revealed by 
the examination. Toward this end it urges the expansion of the public 
health services of the State, to include a complete public health unit 
in every health district, furnishing, particularly, adequate public 
health nurse service and supervision for the schools. All these mat- 
ters of health will require close cooperation and understanding, and 
perhaps memorandums of agreement between the State Department 
of Health and the State Department of Education at both the State 
and local levels.” 24 
Senate Document No. 7 
An intensive study of this problem has been made by the State De- 
partment of Health during the past eighteen months, and the results of 
this study were available to the members of this Commission. On the basis 
of the study conducted by the State Health Department, and from the 
further consideration of the subject by this Commission, we find and 
reach the following facts and conclusions: 
1. That there are approximately 560,000 school children in 
the State of Virginia, of whom it is estimated that over one-half 
have some physical defect. 
2. That sampling has shown that most of the defects which 
exist in school children can be corrected. 
3. That no state-wide plan is now in operation for a proper pe- 
riodic medical examination of these school children. 
4. That the school health service should be divided into two 
phases, namely a program of health education and a program of 
medical service. 
5. That compulsory periodic medical examination should be 
required of all school children in Virginia. 
6. That the responsibility for school health medical service be 
made an integral part of the health services rendered by local health 
departments. 
The limit to which a school health service may be expanded is bound- 
ed only by the interest and support which such a service can receive from 
the general public. While it might appear desirable to set up a school 
health service so comprehensive that even the most detailed medical needs 
of the school child were met, such a program would not only place undue 
emphasis on this phase of the community’s public health activity, but 
would also prove to be more expensive than public opinion might justify. 
Failure of such a program would be then due, not to lack of results, but 
to its perfection which was more advanced than public opinion at the 
time. It appears therefore desirable to set up a school program reasonably 
consistent with present progress of the general public’s education and 
reasonably consistent with available facilities, funds, and personnel. 
Effective plans can and should be worked out by the Department of 
Health for remedying the defects discovered by the medical examination 
of the school children. 
Coordinated with the general health program and handled as a 
health function under the Department of Health, the cost would likely 
be around $500,000 per year. This may seem expensive on first thought, 
but ultimately it will be considered as money wisely spent and will even- 
tually pay tremendous dividends. 
For sake of brevity the Commission will not enter into a discussion 
of the details which were considered by it for the execution of this plan. 
Suffice it to say that your Commission feels that the program for the 
medical examination of school children and the correction of the exist- Health, Hospital and Medical Care Needs of Virginia 
25 
ing defects can best be carried out by the Department of Health working 
with the practicing physicians and dentists of the State. On this point] 
reference is made to “Plans for a School Health Service in Virginia” and 
study of “Estimated Costs for Medical and Dental Examination of School 
Children in Virginia” prepared by the Department of Health. 
In many instances, the provision of adequate facilities for the cor- 
rection of defects will be found to be the most difficult hurdle encountered 
in a school health service. It is recognized that without providing some 
means to secure correction of the various defects found in school children, 
the physical examination is of little value so far as final results to the 
individual are concerned. The lay public is unable to measure the educa- 
tional results obtained or visualize the possible later effects of an exam- 
ination program unless tangible corrective figures are available. 
Conclusion 
It must be realized that the many phases of health studies involve 
changing circumstances and conditions. Old problems will continue to 
be present; new problems will arise. A single continuing Health Com- 
mission to study, coordinate, and integrate all health problems of Virginia 
would be of great help in solving such problems. Such studies must keep 
step with the present and provide for the future. This is a large task, but 
it is one in which cooperative and unselfish work may be expected. 
Health studies necessarily must overlap, but we feel that it would 
be well-nigh impossible to devote too much time to the consideration of 
such an important subject. To provide for the health of the people is one 
of the most important functions of government. The health of the people 
is of equal importance to the education of the people. It is the foundation 
of the welfare of the Commonwealth. The time has arrived when we 
should say that no person in Virginia shall lack adequate hospital or medi- 
cal care because of his status in life. 
Respectfully submitted, 
I. C. Riggin, Chairman 
J. D. Hagood, Vice-Chairman 
H. B. Mulholland 
Wm. B. Porter 
Jack W. Witten 
Parke P. Deans 
J. Maynard Magruder 
Jos. J. Williams, Jr. 
Ted Dalton 26 
Senate Document No. 7 
CAUSE OF DEATH 
1944 
1943 
1942 
1941 
1940 
1939 
1938 
1937 
1936 
1935 
Va. 
U. S. 
Va. 
U. S. 
Va. 
U. S. 
Va. 
U. S. 
Va. 
U. S. 
Va. 
U. S. 
Va. 
U. S. 
Va. 
U. S. 
Va. 
u. s. 
Va. 
U. S. 
Syphilis 
Diarrhea and Enteritis 
Acute Rheumatic Fever and Chronic 
Rheumatic Heart Disease 
Premature Birth (per 100,000 popula- 
tion) 
Infant Mortality 
Maternal Mortality 
Tuberculosis (all forms) 
Cancer 
12.1 
12.8 
19.4 
34.9 
48.3 
2.8 
46.0 
90.5 
13.1 
11.3 
17.9 
34.5 
48.4 
2.9 
48.7 
82.4 
12.1 
. 9.6 
21.4 
25.8 
40.4 
2.5 
42.6 
124.5 
14.8 
13.6 
20.6 
35.6 
53 8 
3.3 
56.7 
84.2 
12.2 
8.8 
20.0 
25.8 
40.4 
2.6 
43,1 
122.1 
14.7 
20.0 
19.2 
36.3 
66.8 
3.9 
59.3 
82.9 
13 3 
10.5 
21.0 
25.1 
45 3 
3.2 
44.5 
120.2 
17.3 
11.8 
21.5 
36.3 
59.2 
4 5 
58.1 
82.2 
14.4 
10.3 
22.1 
24.5 
47.0 
3.8 
45,8 
120.0 
18.2 
15.1 
15.0 
11.6 
18.0 
20.9 
15.9 
14 3 
20.1 
18.1 
16.1 
14.7 
18.6 
20.9 
16.2 
16.4 
16 4 
17,8 
15 4 
14.1 
37.9 
60.8 
5.1 
60.9 
81 1 
24 6 
48.0 
4.0 
47.1 
117.5 
37.5 
66.1 
5.3 
68.7 
83.8 
25.2 
51 0 
4.4 
49 1 
114.9 
38.9 
69.8 
5.6 - 
67.4 
78.8 
26.1 
54.4 
4.9 
53.8 
112.4 
40.6 
73.9 
5.8 
74.3 
80.4 
26.3 
57.1 
5.7 
55.9 
111.4 
39.9 
69.4 
5.6 
76.2 
81.3 
26.0 
55,7 
5.8 
55 1 
108.2 
State of Virginia 
Premature Birth (per 1,000 live 
births) 
14.9 
14.5 
15.4 
17.1 
17.7 
19.1 
18.5 
19.6 
20.5 
19.9 
U. S. publications give premature birth per 100,000 population instead of per 1,000 live births for U. S. preceding 1941. 
Noth: The combination of “Acute Rheumatic Fever and Chronic Rheumatic Heart Disease” is not available in U. S. Tabulations prior to 1939. 
Among the 10 leading causes of death in Virginia, “Acute Rheumatic Fever and Chronic Rheumatic Heart Disease” are included in all “Diseases of the Heart”, Rank 1. If they were 
shown separately they would come in the 9th position for years 1944, 1943, 1941, 1940, and in the 10th position in 1942. 
Data for U. S. for the year 1944 not yet available. 
Maternal and infant mortality rates per 1,000 live births. 
All other causes of death are listed as deaths per 100,000 population. 
Death Rates in the State of Virginia and the United States for the Ten-Year Period (1935-1944) 
for the Following Causes 
TABLE I Health, Hospital and Medical Care Needs of Virginia 
27 
DISEASE 
Jan. 
Feb. 
March 
April 
May 
June 
July 
August 
Sept. 
Oct. 
Nov. 
Dec. 
Meningitis 
16 
14 
21 
21 
23 
13 
11 
13 
9 
12 
6 
26 
Diphtheria 
56 
37 
39 
27 
21 
14 
18 
35 
44 
89 
117 
67 
Poliomyelitis 
3 
1 
1 
2 
2 
2 
8 
27 
34 
33 
30 
8 
Rocky Mountain 
Spotted Fever 
0 
1 
0 
0 
2 
8 
11 
14 
7 
3 
1 
0 
Scarlet Fever 
206 
155 
200 
167 
148 
64 
42 
50 
90 
178 
298 
212 
Tularemia 
12 
3 
4 
1 
2 
3 
1 
3 
2 
3 
2 
9 
Typhoid Fever 
10 
6 
8 
9 
11 
12 
25 
32 
33 
31 
16 
12 
Typhus Fever 
1 
1 
0 
0 
1 
0 
1 
1 
3 
2 
6 
1 
Undulant Fever 
2 
2 
0 
2 
3 
4 
3 
3 
2 
3 
3 
1 
*Total 
306 
220 
273 
229 
213 
120 
120 
178 
224 
354 
479 
336 
‘Possible hospital case load by months of common communicable diseases. 
Five-Year Monthly Median of Cases—1940-1944 
TABLE II 28 
Senate Document No. 7 
TABLE III 
DECREASE IN DEATHS FROM CERTAIN CAUSES 
OVER A 25-YEAR PERIOD 
Deaths 
1920 
Rates 
1944 
Deaths 
Rates 
Typhoid 
260 
11.2 
11 
0.4 
Diphtheria 
334 
14.4 
23 
0.8 
Tuberculosis (all forms) 
3319 
143.4 
1287 
46.0 
Diarrhea and Dysentery 
(under 2) 
1036 
44.8 
336 
12.0 
Diarrhea and Dysentery 
(over 2) 
455 
19.7 
95 
3.4 
Infants under one year 
5500 
81.4 
3172 
48.4* 
Maternal 
569 
8.4 
182 
2.8* 
*Per 1,000 live births. Health, Hospital and Medical Care Needs of Virginia 
29 
TABLE IV 
TABLE SHOWING THE COMPONENT PARTS 
OF THE FOUR ADMINISTRATIVE DISTRICTS 
Southwest: 
8 one-county districts 
8 
counties 
7 two-county districts 
14 
counties 
15 
22 
Southeast: 
2 one-county districts 
2 
counties 
4 two-county districts 
8 
counties 
2 three-county districts 
6 
counties 
1 four-county district 
4 
counties 
9 
20 
• 
Northern: 
7 one-county districts 
7 
counties 
5 two-county districts 
10 
counties 
3 three-county districts 
9 
counties 
1 four-county district 
4 
counties 
16 
30 
Central: 
4 one-county districts 
4 
counties 
5 three-county districts 
15 
counties 
1 four-county district 
4 
counties 
1 five-county district 
5 
counties 
11 
28 
Recapitulation 
Southwest Administrative District: 15 health districts comprising 22 counties. 
Southeast Administrative District: 9 health districts comprising 20 counties. 
Northern Administrative District: 16 health districts comprising 30 counties. 
Central Administrative District: 11 health districts comprising 28 counties. 
51 100 Health, Hospital and Medical Care Needs of Virginia 
31 
Showing 
Health and Administrative Districts 
Map I 
Administrative Districts 
Health Districts